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Functional Medicine
IVs
Peptides
FAQ Functional Medicine
Coaching
Blog
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Vitamin Injections
Skin (Surface Level)
Medical Weightloss
Nurse Kim
Nurse Kim
Quick Links
Functional Medicine
Skincare
Blog
First name
Last name
Family History
Do you drink?
Yes
No
Do you smoke?
Yes
No
Marijuana use?
CBD use?
Allergies?
Favorite foods?
Food dislikes?
What is your daily water intake?
Food Sensitivites? If yes, please expalin
Any interactions with medications or pr vitamins?
Vitamins currently taking:
What is your biggest health concern?
Last time seen by a Dr?
What was your last visit for?
Last lab work?
Worrisome results?
Yes
No
If yes, what were the results?
Sleep issues?
How many hours of sleep do you get per night?
Are your tired during the day? If yes, when?
Any caffeine? How much?
Skin rashes?
Yes
No
Skin sensitivities?
Yes
No
Hair loss or growth?
Yes
No
Ever had any testing before? What were your results?
Do you have a copy of your results?
Yes
No
Do you stress eat?
Functional Medicine
IVs
Peptides
FAQ Functional Medicine
Coaching
Blog
Coming Soon
Vitamin Injections
Skin (Surface Level)
Medical Weightloss
Nurse Kim
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